Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, 210006, Nanjing, China.
Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, Buffalo, USA.
J Headache Pain. 2021 Nov 13;22(1):137. doi: 10.1186/s10194-021-01348-x.
Post-traumatic headache (PTH) is a very common symptom following mild traumatic brain injury (mTBI), yet much remains unknown about the underlying pathophysiological mechanisms of PTH. Neuroimaging studies suggest that aberrant functional network connectivity (FNC) may be an important factor in pain disorders. The present study aimed to investigate the functional characteristics of static FNC (sFNC) and dynamic FNC (dFNC) in mTBI patients with PTH.
With Institutional Review Board (IRB) approval, we prospectively recruited 50 mTBI patients with PTH, who were diagnosed with ICHD-3 beta diagnostic criteria and 39 mTBI without PTH who were well matched for age, gender and education. Resting-state functional magnetic resonance imaging (fMRI) scanning (3.0 T, Philips Medical Systems, Netherlands), Montreal Cognitive Assessment (MoCA) and headache symptom measurement (headache frequency and headache intensity) were performed. The resting-state fMRI sequence took 8 min and 10 s. Independent component analysis and sliding window method were applied to examine the FNC on the basis of nine resting-state networks, namely, default mode network (DMN), sensorimotor network (SMN), executive control network (ECN), auditory network (AuN), attention network (AN), salience network (SN), visual network (VN), and cerebellum network (CN). The differences in sFNC and dFNC were determined and correlated with clinical variables using Pearson rank correlation.
For sFNC, compared with mTBI patients without PTH, mTB with PTH group showed four altered interactions, including decreased interactions in SN-SMN and VN-DMN pairs, increased sFNC in SN-ECN and SMN-DMN pairs. For dFNC, significant group differences were found in State 2, including increased connectivity alteration in the DMN with CN, DMN with SMN, and AuN with CN. Significant reduced connectivity changes in the DMN with VN was found in State 4. Furthermore, the number of transitions (r=0.394, p=0.005) between states was positively associated with headache frequency. Additionally, dwell time (r=-0.320, p=0.025) in State 1 was negatively correlated with MoCA score.
MTBI patients with PTH are characterized with altered sFNC and dFNC, which could provide new perspective to understand the neuropathological mechanism underlying the PTH to determine more appropriate management, and may be a useful imaging biomarker for identifying and predicting mTBI with PTH.
创伤后头痛（PTH）是轻度创伤性脑损伤（mTBI）后非常常见的症状，但 PTH 的潜在病理生理机制仍知之甚少。神经影像学研究表明，异常的功能网络连接（FNC）可能是疼痛障碍的一个重要因素。本研究旨在探讨 mTBI 伴 PTH 患者的静息态功能网络连接（sFNC）和动态功能网络连接（dFNC）的功能特征。
本研究经机构审查委员会（IRB）批准，前瞻性招募了 50 例 mTBI 伴 PTH 患者，这些患者根据 ICHD-3 beta 诊断标准诊断为 PTH，并招募了 39 例 mTBI 不伴 PTH 的患者作为年龄、性别和教育程度相匹配的对照组。进行静息态功能磁共振成像（fMRI）扫描（3.0 T，荷兰飞利浦医疗系统）、蒙特利尔认知评估（MoCA）和头痛症状测量（头痛频率和头痛强度）。静息态 fMRI 序列持续 8 分钟 10 秒。应用独立成分分析和滑动窗口方法，基于默认模式网络（DMN）、感觉运动网络（SMN）、执行控制网络（ECN）、听觉网络（AuN）、注意网络（AN）、突显网络（SN）、视觉网络（VN）和小脑网络（CN）等 9 个静息态网络，检测 FNC。采用 Pearson 秩相关分析，确定 sFNC 和 dFNC 的差异，并与临床变量相关。
对于 sFNC，与 mTBI 不伴 PTH 患者相比，mTBI 伴 PTH 组表现出四个改变的相互作用，包括 SN-SMN 和 VN-DMN 对的相互作用减少，SN-ECN 和 SMN-DMN 对的 sFNC 增加。在状态 2 中，dFNC 存在显著的组间差异，包括 DMN 与 CN、DMN 与 SMN 和 AuN 与 CN 的连接改变增加。在状态 4 中，发现 DMN 与 VN 的连接改变减少。此外，状态之间的转换次数（r=0.394，p=0.005）与头痛频率呈正相关。此外，状态 1 中的停留时间（r=-0.320，p=0.025）与 MoCA 评分呈负相关。
mTBI 伴 PTH 患者表现出 sFNC 和 dFNC 的改变，这可能为理解 PTH 背后的神经病理学机制提供新的视角，以确定更合适的治疗方法，并且可能是识别和预测 mTBI 伴 PTH 的有用影像学生物标志物。
